Take for example a couple of the latest antibiotics on the block, tigecycline and ceftaroline.
As new, broad spectrum anti-microbials they should be given the utmost protection in order to prevent selection of antibiotic resistance, only being used in cases where there are few or no other reasonable options available.
The pharmaceutical companies will not tell you this however. They would like you to use the drug as much as possible, for obvious reasons.
…and sometimes general physicians will have heard of these new antibiotics and because they are new, assume they are the best, and seek to use them.
… and sometimes Clinical Microbiologists and ID physicians like to use new antibiotics like these because it makes them look clever, or in order to stay ahead of “the game”.
….and sometimes pharmacists feel the compulsion to stock a few vials of all the exotic antibiotics, just in case…
….and sometimes the CEO will want these antibiotics used in his/her hospital, because other neighbouring hospitals are using them.
….and sometimes the patient will have heard of the latest new antibiotic on the news or internet, and demand its use.
Protection of antibiotics like these starts in the laboratory, with focused testing and reporting. It always has done, always will do. If you test or report any such antibiotics on a routine basis, you need to take a long hard look at your laboratory policy.
I have hardly ever reported or advised the use of these antibiotics, because in the area of the world I work in, there is very little need for them. I suspect this will be the case for the vast majority of us.
When we make decisions on which antibiotics to test, which to report, which to advise etc, there may be several opinions given to you, or subtle pressure applied from various sources.
Listen to the advice, be aware of the agendas, and always, always make up your own mind.